Provider Demographics
NPI:1598064768
Name:ADCOCK ACUPUNCTURE & CHINESE MEDICAL ARTS, LLC
Entity Type:Organization
Organization Name:ADCOCK ACUPUNCTURE & CHINESE MEDICAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:770-853-7002
Mailing Address - Street 1:3787 HARTS MILL CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1730
Mailing Address - Country:US
Mailing Address - Phone:770-853-7002
Mailing Address - Fax:
Practice Address - Street 1:3 DUNWOODY PARK
Practice Address - Street 2:SUITE 126
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7405
Practice Address - Country:US
Practice Address - Phone:770-853-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000139171100000X
GA000185171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty